ArticleJournal of the International AIDS Society2015
Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia.
Article in Journal of the International AIDS Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 5 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The impact of Option B+ on mother-to-child transmission of HIV in Africa: A systematic review.Tropical medicine & international health : TM & IH · 2022Pooled it
- Birth and death notification via mobile devices: a mixed methods systematic review.The Cochrane database of systematic reviews · 2021Pooled it
- Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review.BMC public health · 2018Pooled it
- Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis.Journal of the International AIDS Society · 2017Pooled it
- HIV-free survival at 12-24 months in breastfed infants of HIV-infected women on antiretroviral treatment.Tropical medicine & international health : TM & IH · 2016Pooled it
- A Protocol for a Cluster Randomized Trial on the Effect of a "feeding buddy" Program on adherence to the Prevention of Mother-To-Child-Transmission Guidelines in a Rural Area of KwaZulu-Natal, South Africa.Journal of acquired immune deficiency syndromes (1999) · 2016Trial
- Perspective: Infant Feeding Policies among Women Living with HIV in Latin America and the Caribbean: Should They Be Updated?Advances in nutrition (Bethesda, Md.) · 2026Article
- Postnatal HIV vertical transmission and the impact of infant feeding choice in the ART era.Southern African journal of HIV medicine · 2025Review
- Feeding modalities, HIV transmission and its predictors among HIV-exposed infants visited Gamo and Gofa zones public health facilities, Southern Ethiopia: a retrospective follow up study.BMC pediatrics · 2024Article
- Viruses and Human Milk: Transmission or Protection?Advances in nutrition (Bethesda, Md.) · 2023Review
- Improving WHO's understanding of WHO guideline uptake and use in Member States: a scoping review.Health research policy and systems · 2022Article
- Sociodemographic and lifestyle correlates of exclusive breastfeeding practices among mothers on antiretroviral therapy in the Eastern Cape, South Africa.International breastfeeding journal · 2021Article
- Experiences and Reasons of Attrition from Option B+ Among Mothers Under Prevention of Mother to Child Transmission Program in Northwest Ethiopia: Qualitative Study.HIV/AIDS (Auckland, N.Z.) · 2021Article
- Support or control? Qualitative interviews with Zambian women on male partner involvement in HIV care during and after pregnancy.PloS one · 2020Article
- Risks and Benefits of Dolutegravir- and Efavirenz-Based Strategies for South African Women With HIV of Child-Bearing Potential: A Modeling Study.Annals of internal medicine · 2019Article
- Article
- Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland.BMC public health · 2018Article
- HIV-1 transmission and survival according to feeding options in infants born to HIV-infected women in Yaoundé, Cameroon.BMC pediatrics · 2018Article
- Impact of Timing of Antiretroviral Treatment and Birth Weight on Mother-to-Child Human Immunodeficiency Virus Transmission: Findings From an 18-Month Prospective Cohort of a Nationally Representative Sample of Mother-Infant Pairs During the Transition From Option A to Option B+ in Zimbabwe.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Observational
- 24-month HIV-free survival among infants born to HIV-positive women enrolled in Option B+ program in Kigali, Rwanda: The Kabeho Study.Medicine · 2017Article
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionTo prevent mother-to-child transmission (MTCT) of HIV in developing countries, new World Health Organization (WHO) guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB). The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented.
methodsA prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up.
resultsTotal MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI) 2.2-7.6%). All breastfeeding transmissions that could be timed (5/5) occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001). Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04). Infant mortality was lower after six months of age than during the first six months of life (p=0.02). The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5-20.8%).
conclusionsMaternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB.
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